Helga Wanglie was an eighty-five-year-old woman with multiple health challenges who was kept alive on a respirator. Her heart stopped during one attempt to wean her off of the respirator and she was resuscitated. After five-and-a-half months when she was completely inactive, doctors pronounced her to be in a persistent vegetative state (PVS), unable to have or recover the kind of experiences characteristic of human life.
Her husband objected to the removal of the respirator that was keeping her alive. He claimed that life itself is a benefit, the same claim made some years later by those who opposed removing nutrition and hydration from PVS diagnosed Terry Schiavo. In the Schiavo case, the husband sought removal which he claimed she would have wanted, and it was others who claimed that her wishes weren’t clear and that life itself is a benefit. In Ms. Wanglie’s case, the patient’s wishes were truly unknown, and her husband wanted continued use of the respirator.
The physicians and the clinical ethicist at Hennepin County Medical Center in Minnesota believed that, being in a persistent vegetative state, Ms. Wanglie was not receiving any benefit from continued life any more than a plant benefits from continued life. The goal of healthcare among human beings is limited to promoting the longevity and quality of lives that have, or could have, distinctly human qualities.
On the other hand, we should be cautious about determining that lives with certain disabilities aren’t worth living. Many people who would say, for example, that they wouldn’t want to continue living as a paraplegic person needing a wheelchair find out when in that condition that the quality of their lives isn’t nearly as impaired as they thought it would be by such a disability. But, as far as we can tell, there is no quality of life, because there is no conscious life with PVS.
Another consideration is the possibility of mis-diagnoses of PVS. People diagnosed with PVS have awakened months or even years after their (apparently incorrect) diagnoses. Some of those in Mr. Wanglie’s situation pray for a miracle and actually get what they want. Second, the value of continued human life isn’t a medical question, so doctors aren’t particularly well qualified to make decisions on this matter for other people.
However, there is a down side to continued use of the respirator. Insurance paid for Ms. Wanglie’s continued care, but that just means that the cost was spread among many people, not that use of the respirator was free. Did people who signed up for insurance expect to fund continued expenditures on treatments that medical professional consider useless? I’m skeptical that they did. What’s more, most insurance for the elderly is covered by Medicare, which is funded by the government on the basis of taxes paid by everyone, including younger adults.
About 18 percent of the gross domestic product (GDP), the value of all goods and services in our economy, goes to healthcare. Many people think that this amount, which is about twice what is spent in other countries with health outcomes equal to or better than our own, reduces what we can spend on early childhood education, assistance for needy families, university education, the training of needed workers, healthcare for the uninsured, roads and other infrastructure.
But isn’t turning off the respirator causing her death, that is, killing her? A cause is generally speaking “what makes something happen.” You could say that turning off the respirator causes her death because it makes that happen. But you could equally say that it’s her health challenges that cause her death, because without those challenges she wouldn’t need the respirator in the first place. You can choose either one of these - health difficulties or lack of respirator as the cause of her death.
Still, where life is concerned, shouldn’t we always err on the safe side and keep people alive if at all possible? Not necessarily. We lock people up and sometimes put them to death because they are found by a jury of their peers to be guilty “beyond a reasonable doubt.” This is the standard, rather than “absolute certainty,” because certainty is most often unavailable. So, the fact that some people have on very rare occasions been mis-diagnosed with PVS shouldn’t prevent us from trusting the diagnoses of medical professionals.
Of course, the human mind is a mystery in many ways. There are people with significant mentation but have locked-in syndrome, which make them unable to communicate in normal ways. It would be easy for those untrained in medicine to think such a person suffers from PVS, but this was already taken into account by Ms. Wanglie’s physicians. Sad as it may be, our society may not be able to afford keeping people alive based on nothing more than hope for a miracle.
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